1
|
Paquin V, Cupo L, Malla AK, Iyer SN, Joober R, Shah JL. Dynamic association of the first identifiable symptom with rapidity of progression to first-episode psychosis. Psychol Med 2023; 53:2008-2016. [PMID: 34538292 DOI: 10.1017/s0033291721003755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rapid progression from the first identifiable symptom to the onset of first-episode psychosis (FEP) allows less time for early intervention. The aim of this study was to examine the association between the first identifiable symptom and the subsequent speed of illness progression. METHODS Data were available for 390 patients attending a catchment-based early intervention service for FEP. Exposure to non-psychotic and subthreshold psychotic symptoms was retrospectively recorded using semi-structured interviews. Outcomes following the onset of the first identifiable symptom were (1) time to onset of FEP and (2) symptom incidence rate (i.e. number of symptoms emerging per person-year until FEP onset). These outcomes were respectively analyzed with Cox proportional hazards and negative binomial regressions. RESULTS After Bonferroni correction, having a subthreshold psychotic (v. non-psychotic) symptom as the first symptom was not associated with time to FEP onset [hazard ratio (HR) = 1.39; 95% CI 0.94-2.04] but was associated with higher symptom incidence [incidence rate ratio (IRR) = 1.92; 95% CI 1.10-3.48]. A first symptom of suspiciousness was associated with shorter time to FEP onset (HR = 2.37; 95% CI 1.38-4.08) and higher symptom incidence rate (IRR = 3.20; 95% CI 1.55-7.28) compared to other first symptoms. In contrast, a first symptom of self-harm was associated with lower symptom incidence rate (IRR = 0.06; 95% CI 0.01-0.73) compared to other first symptoms. Several associations between symptoms and illness progression were moderated by the age at symptom onset. CONCLUSIONS Appreciating the content and timing of early symptoms can identify windows and treatment targets for early interventions in psychosis.
Collapse
Affiliation(s)
- Vincent Paquin
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Lani Cupo
- Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
| |
Collapse
|
2
|
Hermans K, van der Steen Y, Kasanova Z, van Winkel R, Reininghaus U, Lataster T, Bechdolf A, Gimpel-Drees J, Wagner M, Myin-Germeys I. Temporal dynamics of suspiciousness and hallucinations in clinical high risk and first episode psychosis. Psychiatry Res 2020; 290:113039. [PMID: 32460186 DOI: 10.1016/j.psychres.2020.113039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
The objective of the current study is to elucidate the temporal dynamics of suspiciousness and hallucinations as they occur in daily life in the early stages of psychosis. Their prevalence and co-occurrence, as well as their temporal relation to affect and delusions, were compared between patients with a first psychotic episode (FEP) and individuals at clinical high risk for psychosis (CHRp). The Experience Sampling Method was used to investigate suspiciousness and hallucinatory experiences, delusions, and affect at semi-random moments throughout six days in 33 CHRp and 34 FEP. Overall, 91% of CHRp and 59% of FEP reported suspiciousness, and 24% and 39% reported hallucinations, respectively. Hallucinations almost always co-occurred with suspiciousness, whereas suspiciousness was often present without hallucinations. Suspicious episodes in CHRp occurred with marked increases in delusional intensity, while hallucinatory experiences were mostly absent. In FEP, a decrease of positive affect preceded suspicious episodes, while an increase of negative affect preceded hallucinatory episodes. Our results indicated the presence of a delusional mood (atmosphere) in CHRp as an experience in itself, without co-occurring or following hallucinations, thus refuting the anomalous experience hypothesis of psychosis. The co-occurrence of hallucinations, on the other hand, indicates a more severe stage of symptomatology.
Collapse
Affiliation(s)
- Karlijn Hermans
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium.
| | - Yori van der Steen
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; Maastricht University, School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry & Neuropsychology, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven en de Kempen, Eindhoven, The Netherlands
| | - Zuzana Kasanova
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Ruud van Winkel
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Leuvensesteenweg, Kortenberg, Belgium; Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | - Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Tineke Lataster
- Maastricht University, School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry & Neuropsychology, Maastricht, The Netherlands
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany; Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Judith Gimpel-Drees
- University of Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
| | - Michael Wagner
- University of Bonn, Department of Neurodegenerative Diseases and Geriatric Psychiatry, Bonn, Germany
| | - Inez Myin-Germeys
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| |
Collapse
|
3
|
Bang M, Park JY, Kim KR, Lee SY, Song YY, Kang JI, Lee E, An SK. Suicidal ideation in individuals at ultra-high risk for psychosis and its association with suspiciousness independent of depression. Early Interv Psychiatry 2019; 13:539-545. [PMID: 29164799 DOI: 10.1111/eip.12517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/22/2017] [Accepted: 09/30/2017] [Indexed: 12/28/2022]
Abstract
AIM Psychotic experiences, including delusions and hallucinations, and their attenuated forms have been recently suggested as a significant but under-recognized marker of suicide risk. However, the relationship between attenuated positive symptoms and suicide has not yet been clearly demonstrated in individuals at ultra-high risk (UHR) for psychosis. Here, we investigated the effect of attenuated positive symptoms on suicidal ideation in UHR individuals. METHODS Fifty-three healthy controls (HCs) and 74 UHR individuals participated in the present study. All participants were assessed for the intensity of suicidal ideation and depressive symptoms at baseline. The effect of attenuated positive symptoms on suicidal ideation in the UHR group was examined using a multiple linear regression analysis after adjustment for concurrent depressive symptoms. RESULTS UHR participants were found to have significantly greater suicidal ideation and more severe depressive symptoms compared to those of HCs. The regression model demonstrated that suspiciousness significantly increased suicidal ideation in UHR participants, independent of the severity of depressive symptoms. CONCLUSION The findings of the present study suggest that suspiciousness may serve as a risk indicator for suicide in clinical practice for UHR individuals. It is crucial to focus on the risk of suicide in the UHR population, as they require sufficient clinical attention and proper management for crises related to their unusual and confusing experiences.
Collapse
Affiliation(s)
- Minji Bang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Young Lee
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Yun Young Song
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
4
|
Fisher JE, Miller GA, Sass SM, Silton RL, Edgar JC, Stewart JL, Zhou J, Heller W. Neural correlates of suspiciousness and interactions with anxiety during emotional and neutral word processing. Front Psychol 2014; 5:596. [PMID: 25018737 PMCID: PMC4073627 DOI: 10.3389/fpsyg.2014.00596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Abstract
Suspiciousness is usually classified as a symptom of psychosis, but it also occurs in depression and anxiety disorders. Though how suspiciousness overlaps with depression is not obvious, suspiciousness does seem to overlap with anxious apprehension and anxious arousal (e.g., verbal iterative processes and vigilance about environmental threat). However, suspiciousness also has unique characteristics (e.g., concern about harm from others and vigilance about social threat). Given that both anxiety and suspiciousness have been associated with abnormalities in emotion processing, it is unclear whether it is the unique characteristics of suspiciousness or the overlap with anxiety that drive abnormalities in emotion processing. Event-related brain potentials were obtained during an emotion-word Stroop task. Results indicated that suspiciousness interacts with anxious apprehension to modulate initial stimulus perception processes. Suspiciousness is associated with attention to all stimuli regardless of emotion content. In contrast, anxious arousal is associated with a later response to emotion stimuli only. These results suggest that suspiciousness and anxious apprehension share overlapping processes, but suspiciousness alone is associated with a hyperactive early vigilance response. Depression did not interact with suspiciousness to predict response to emotion stimuli. These findings suggest that it may be informative to assess suspiciousness in conjunction with anxiety in order to better understand how these symptoms interact and contribute to dysfunctional emotion processing.
Collapse
Affiliation(s)
- Joscelyn E Fisher
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences Bethesda, MD, USA
| | - Gregory A Miller
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology, University of California Los Angeles Los Angeles, CA, USA ; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Los Angeles, CA, USA
| | - Sarah M Sass
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology and Counseling, University of Texas at Tyler Tyler, TX, USA
| | - Rebecca Levin Silton
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology, Loyola University Chicago, IL, USA
| | - J Christopher Edgar
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Radiology, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - Jennifer L Stewart
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychiatry, University of California San Diego San Diego, CA, USA
| | - Jing Zhou
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences Bethesda, MD, USA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA
| |
Collapse
|
5
|
Klaassen RMC, Heins M, Luteijn LB, van der Gaag M, van Beveren NJM. Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls. Psychol Med 2013; 43:747-756. [PMID: 22804999 DOI: 10.1017/s0033291712001572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression is a clinically relevant dimension, associated with both positive and negative symptoms, in patients with schizophrenia. However, in siblings it is unknown whether depression is associated with subclinical positive and negative symptoms. Method Depressive symptoms and their association with positive and negative symptoms were examined in 813 healthy siblings of patients with a non-affective psychotic disorder, 822 patients and 527 healthy controls. Depressive episodes meeting DSM-IV-TR criteria (lifetime) and depressed mood (lifetime) were assessed with the Comprehensive Assessment of Symptoms and History (CASH) in all three groups. In the patient group, the severity of positive and negative psychosis symptoms was assessed with the CASH. In the siblings and healthy controls, the severity of subclinical psychosis symptoms was assessed with the Community Assessment of Psychic Experiences (CAPE). RESULTS Patients reported more lifetime depressed mood and more depressive episodes than both siblings and controls. Siblings had a higher chance of meeting lifetime depressive episodes than the controls; no significant differences in depressed mood were found between siblings and controls. In all three groups the number and duration of depressive symptoms were associated with (sub)clinical negative symptoms. In the patients and siblings the number of depressive symptoms was furthermore associated with (sub)clinical positive symptoms. Finally, lifetime depressed mood showed familial clustering but this clustering was absent for lifetime depressive episodes. CONCLUSIONS These findings suggest that a co-occurring genetic vulnerability for both depressive and psychotic symptomatology exists on a clinical and a subclinical level.
Collapse
|
6
|
Rössler W, Angst J, Gamma A, Haker H, Stulz N, Merikangas KR, Ajdacic-Gross V. Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study. Eur Arch Psychiatry Clin Neurosci 2011; 261:11-9. [PMID: 20625755 PMCID: PMC3006160 DOI: 10.1007/s00406-010-0123-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 06/25/2010] [Indexed: 11/25/2022]
Abstract
The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. In this study, we analyzed the interplay between two subclinical psychosis symptoms dimensions, and one depression symptoms dimension, using longitudinal data from Zurich. The Zurich study started in 1979 with a representative sample of 591 participants who were aged 20/21. Follow-up interviews were conducted at age 23, 28, 30, 35, and 41. The psychiatric symptoms were assessed with a semi-structured interview and the SCL 90-R. In this study, we analyzed three SCL-90-R subscales: the depression symptoms dimension and two distinct symptoms dimensions of subclinical psychosis, one representing a schizophrenia nuclear symptom dimension, the other representing a schizotypal symptoms dimension. Modeling was done with hybrid latent growth models, thereby including simultaneous and cross-lagged effects. The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.
Collapse
Affiliation(s)
- Wulf Rössler
- Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
There is a high prevalence of suicidal behavior in individuals suffering from schizophrenia and recent investigations substantially elucidate this problem and provide useful insights about clinical risk factors, neurobiologic underpinnings and the impact of various treatments on reducing such behavior. The risk of suicide is greatest early in the course of schizophrenic illness but continues throughout life; risk factors for suicidal behavior include psychosis, depression and substance abuse. Effectively treating positive symptoms and depression, reducing substance abuse, avoiding akathisia, addressing demoralization and instilling hope are important elements in this treatment approach. The newer generation of atypical antipsychotics (particularly clozapine) and new psychologic approaches (particularly cognitive behavioral therapy) appear to be useful in reducing suicidality in schizophrenia. The significant advances in defining the neurobiologic basis of suicidality may enable the development of more effective treatments. The renewed emphasis on resilience and recovery as desired outcomes in schizophrenia and the accompanying sense of hope encourage optimism about effectively reducing suicidality in schizophrenia. Over the past 10 years, much has been learnt and hopefully this momentum will be translated into increasingly better outcomes.
Collapse
Affiliation(s)
- Rajiv Tandon
- Department of Children and Families, Office of Mental Health, State of Florida, USA.
| |
Collapse
|
8
|
Gavaudan G, Besnier N, Lançon C. Suicide et schizophrénie : évaluation du risque et prévention. ANNALES MEDICO-PSYCHOLOGIQUES 2006. [DOI: 10.1016/j.amp.2005.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
9
|
Abstract
Suicide is a leading cause of death, but it is not well understood or well researched. Our purpose in this review is to summarize extant knowledge on neurobiological and psychological factors involved in suicide, with specific goals of identifying areas particularly in need of future research and of articulating an initial agenda that may guide future research. We conclude that from both neurobiological and psychological perspectives, extant research findings converge on the view that two general categories of risk for suicide can be identified: (a) dysregulated impulse control; and (b) propensity to intense psychological pain (e.g., social isolation, hopelessness), often in the context of mental disorders, especially mood disorders. Each of these categories of risk is underlain at least to some degree by specific genetic and neurobiological factors; these factors in general are not well characterized, though there is emerging consensus that most if not all reside in or affect the serotonergic system. We encourage future theorizing that is conceptually precise, as well as epistemically broad, about the specific preconditions of serious suicidal behavior, explaining the daunting array of suicide-related facts from the molecular to the cultural level.
Collapse
Affiliation(s)
- Thomas E Joiner
- Psychology Department, Florida State University, Tallahassee, FL 32306-1270, USA.
| | | | | |
Collapse
|
10
|
Rector NA. Dysfunctional Attitudes and Symptom Expression in Schizophrenia: Differential Associations With Paranoid Delusions and Negative Symptoms. J Cogn Psychother 2004. [DOI: 10.1891/jcop.18.2.163.65959] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The extent to which dysfunctional attitudes reflecting excessive need for interpersonal acceptance and approval and/or unrealistic performance standards and interpersonal distance are associated with patterns of symptoms in patients with psychiatric disorders other than depression has been hypothesized but little tested. This study aimed to assess the relations among dysfunctional attitudes and symptoms of psychopathology in patients with DSM-IV-diagnosed schizophrenia (N = 56). The interpersonal and performance-related subscales of the Dysfunctional Attitudes Scale (Weisman & Beck, 1978) were assessed in relation to self-report and clinician-based symptom measures of psychosis, general psychopathology, and depression. The severity of paranoid ideation was found to be uniquely associated with elevated need-for-approval scores, whereas the constellation of negative symptoms was found to be uniquely associated with dysfunctional performance beliefs, even after controlling for depression severity. These results provide preliminary support for the importance of personality attributes in the particular expression of symptoms of psychosis.
Collapse
|
11
|
Abstract
Problems with alcohol are a common and important comorbidity in patients with schizophrenia. Previous studies showed an association between depression and alcohol abuse in patients with schizophrenia. Suspiciousness has been shown to be associated with depression. In a population-based study, the authors tested the hypothesis that suspiciousness is associated with alcohol problems in patients with schizophrenia. Data came from the first wave of the five-site Epidemiological Catchment Area study. Baseline clinical and demographic data were analyzed to assess associations between symptoms and an alcohol abuse or dependence diagnosis in patients with a Diagnostic Interview Schedule (DIS) diagnosis of schizophrenia. Suspiciousness was associated with an alcohol dependence or abuse diagnosis in male DIS-DSM-III schizophrenia patients, after accounting for demographic and other clinical variables. There were no associations between alcohol problems and either conceptual disorganization or hallucinations and nonsuspicious delusions. Suspiciousness appears to be associated with alcohol abuse and dependence in men with schizophrenia. Further studies should attempt to investigate the temporal relationship between suspiciousness and alcohol problems. Interventions that address suspiciousness may decrease the risk of alcohol problems in this population.
Collapse
Affiliation(s)
- Erick Messias
- Preventive Medicine Residency Program, Bloomberg School of Public Health, Department of Mental Hygiene, Johns Hopkins University, Hygiene Building Room WB-608, Baltimore, Maryland 21205, USA
| | | |
Collapse
|
12
|
Altamura AC, Bassetti R, Bignotti S, Pioli R, Mundo E. Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res 2003; 60:47-55. [PMID: 12505137 DOI: 10.1016/s0920-9964(02)00164-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we investigated the possible association between clinical or pharmacological variables and suicidal behavior in a sample of chronic schizophrenia or schizoaffective disorder patients. One hundred and three patients with a DSM-III-R diagnosis of chronic schizophrenia or schizoaffective disorder were studied. The sample was subdivided in two subsamples according to the presence/absence of suicidal attempts lifetime. The main demographic and clinical variables retrospectively collected were analyzed and compared between the two groups. Attempters had a significantly higher rate of nicotine abuse or dependence (chi-square=3.900, df=1, p<0.05, Odds Ratio (O.R.)=3.4), were more likely to have or have had lifetime major depressive episodes (chi-square=10.258, df=1, p<0.002, O.R.=6.5), were more likely to have a duration of untreated psychosis (DUP) > or =1 year (chi-square=6.228, df=1, p<0.02, O.R.=12.5), and were more frequently prescribed typical antipsychotics (chi-square=3.979, df=1, p<0.05, O.R.=6.5) than patients without suicidal attempts lifetime. Further investigations on larger samples and with prospective designs are warranted, particularly with respect to the role of early intervention and atypical antipsychotic treatment in reducing suicide risk in schizophrenic patients.
Collapse
Affiliation(s)
- A C Altamura
- Department of Psychiatry, University of Milan, School of Medicine, Milan, Italy
| | | | | | | | | |
Collapse
|
13
|
Hodgins S, Hiscoke UL, Freese R. The antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment. BEHAVIORAL SCIENCES & THE LAW 2003; 21:523-546. [PMID: 12898506 DOI: 10.1002/bsl.540] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The association between psychotic symptoms and violence is unclear, due in part to methodological features of investigations that have examined this question, and in part to the fact that the association likely differs by disorder and treatment conditions. Using data from The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons, we examined 128 men with schizophrenia or schizoaffective disorder discharged from general and forensic psychiatric hospitals in Canada, Finland, Germany, and Sweden. The association between symptoms and aggressive behavior was studied during two 6 month periods when the patients lived in the community. Severe positive and negative symptoms of psychosis, depression, and anxiety were measured at the beginning of each of the 6 month periods. In addition, at the beginning of the second 6 month period changes in symptoms in the previous period were indexed. Aggressive behavior was measured in each 6 month period by reports from patients and from collaterals. During the first 6 months post-discharge, after controlling for the presence of antisocial personality disorder or PCL score and past diagnoses of alcohol/drug abuse/dependence, the presence of a severe positive symptom significantly increased the risk of aggressive behavior. During the second 6 month period, after controlling for antisocial personality disorder or PCL score and self-reported alcohol/drug use, the presence of a severe positive symptom, a TCO symptom, and an increase in TCO symptoms significantly increased the risk of aggressive behavior. Neither depot medications nor obligatory community treatment reduced the risk of aggressive behavior after controlling for the presence of a severe positive symptom and/or TCO symptoms. These findings suggest that, among men with schizophrenia being treated in the community, the presence of severe psychotic symptoms and the development of TCO symptoms are antecedents of aggressive behavior.
Collapse
Affiliation(s)
- Sheilagh Hodgins
- Department of Forensic Mental Health Science, Institute of Psychiatry, King's College, University of London, London, UK.
| | | | | |
Collapse
|
14
|
Bralet MC, Loas G, Yon V, Maréchal V. Clinical characteristics and risk factors for Kraepelinian subtype of schizophrenia: replication of previous findings and relation to summer birth. Psychiatry Res 2002; 111:147-54. [PMID: 12374632 DOI: 10.1016/s0165-1781(02)00148-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aims of the study were: (1) to replicate findings that patients with Kraepelinian schizophrenia constitute a distinct subgroup and (2) to examine the relationship between season of birth and the Kraepelinian subtype. Thirty-one Kraepelinian patients, defined on the basis of a longitudinal criterion--at least 5 years of continuous and complete dependence on others to maintain the basic necessities of life, including food, clothing and shelter--were compared with 279 non-Kraepelinian schizophrenic patients. All patients met ICD-10 criteria for schizophrenia and were evaluated with the Positive and Negative Syndrome Scale. Kraepelinian schizophrenic patients had more negative symptoms and were more disorganized than non-Kraepelinian patients. Positive and anxious-depressive symptoms did not differ between the two groups. Among Kraepelinian patients, there was an excess number of births in the month of July. These findings are consistent with previous reports that Kraepelinian patients could have a disease with an etiopathophysiology separate from that of other schizophrenic patients.
Collapse
|
15
|
Abstract
Winter birth is a widely replicated risk factor for schizophrenia. However, previous studies have suggested that patients with the deficit syndrome of schizophrenia have an excess of summer births. We tested the summer birth effect in a population-based study. Data came from the Epidemiological Catchment Area study, which had a representative sample of the U.S. population. Psychotic patients with features of the deficit syndrome had a significant association with summer birth, compared with the general population. There was also a significant association between summer birth and the deficit syndrome within the psychotic population, after accounting for the variance due to disorganization, hallucinations and delusions, and demographic characteristics. These findings add to the evidence suggesting the etiopathophysiology of the deficit group differs from that found in other patients with schizophrenia.
Collapse
Affiliation(s)
- E Messias
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore 21228, USA
| | | |
Collapse
|
16
|
Abstract
OBJECTIVE Previous studies suggest suspiciousness is associated with an increased risk of major depressive episodes in psychotic patients. We tested the hypothesis that this relationship would extend to nonpsychotic groups. METHOD Data came from the Epidemiological Catchment Area (ECA) study, a longitudinal population-based study conducted at five sites in the United States. Baseline clinical and demographic features were used to predict the onset of episodes of depression at 1-year follow-up in subjects without psychotic symptoms. RESULTS Subclinical suspiciousness was associated with an increased risk of new episodes of depression after accounting for demographic variables. However, three of six subclinical delusion-like experiences were also associated with an increased risk of depressive episodes. None of the subclinical hallucination-like experiences predicted subsequent risk. CONCLUSION Subclinical suspiciousness appears to increase the risk of depression in the general population. Some other delusion-like experiences may do the same.
Collapse
Affiliation(s)
- E Messias
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, Maryland 21228, USA
| | | |
Collapse
|